Healthcare Provider Details

I. General information

NPI: 1104013531
Provider Name (Legal Business Name): MIDWEST HEALTHSTRATEGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 S. MADISON STREET
MUNCIE IN
47302-5758
US

IV. Provider business mailing address

3813 S. MADISON STREET
MUNCIE IN
47302-5758
US

V. Phone/Fax

Practice location:
  • Phone: 765-751-3300
  • Fax: 765-751-1115
Mailing address:
  • Phone: 765-751-3303
  • Fax: 765-751-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT E. GILDERSLEEVE
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 765-747-3365